Insulin and glucose homeostasis in childhood cancer survivors treated with abdominal radiation: A pilot study

Pediatr Blood Cancer. 2018 Nov;65(11):e27304. doi: 10.1002/pbc.27304. Epub 2018 Jul 15.


Background: Childhood cancer survivors exposed to abdominal radiation (abdRT) are at increased risk for both insulin-dependent and non-insulin-dependent diabetes. We sought to clarify the pathophysiology of diabetes after abdRT by performing dynamic studies of insulin and glucose and testing for type 1 diabetes-associated autoantibodies.

Procedure: Cross-sectional analysis of 2-year childhood cancer survivors treated with abdRT at age ≤21 years who underwent oral glucose tolerance testing and assessment of diabetes-related autoantibodies from December 2014 to September 2016. Prevalence of insulin/glucose derangements, indices of insulin sensitivity/secretion (homeostatic model assessment of insulin resistance [HOMA-IR], whole-body insulin sensitivity, insulinogenic index), autoantibody positivity, and treatment/demographic factors associated with adverse metabolic outcomes were assessed.

Results: Among 40 participants previously exposed to abdRT (57.5% male; median age at cancer diagnosis, 3.3 years [range, 0.5-20.1]; median age at study 14.3 years [range, 8.3-49.8]; none with obesity), 9 (22.5%) had glucose derangements (n = 4 with impaired fasting glucose [≥100 mg/dL]; n = 4 with impaired glucose tolerance [2-hour glucose 140-199 mg/dL]; n = 1 with previously unrecognized diabetes [2-hour glucose ≥200 mg/dL]). Three of the four individuals with impaired fasting glucose also had insulin resistance, as measured by HOMA-IR; an additional four subjects with normal glucose tolerance were insulin resistant. The subject with diabetes had normal HOMA-IR. No participant had absolute insulinopenia or >1 positive diabetes-related autoantibody.

Conclusions: This study suggests that radiation-induced damage to the insulin-producing β-cells is an unlikely explanation for the early derangements in glucose metabolism observed after abdRT. Research into alternative pathways leading to diabetes after abdRT is needed.

Keywords: diabetes; endocrinology; late effects; pediatric oncology; radiation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdomen / radiation effects
  • Adolescent
  • Blood Glucose / analysis
  • Blood Glucose / metabolism*
  • Blood Glucose / radiation effects
  • Cancer Survivors*
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Diabetes Mellitus / epidemiology
  • Female
  • Glucose Intolerance / epidemiology
  • Homeostasis / radiation effects
  • Humans
  • Infant
  • Insulin / blood*
  • Insulin Resistance / radiation effects
  • Male
  • Pilot Projects
  • Radiation Injuries / blood
  • Radiation Injuries / epidemiology*
  • Radiotherapy / adverse effects*
  • Young Adult


  • Blood Glucose
  • Insulin